This document discusses hospital-associated infections (HAIs), also called nosocomial infections. It covers topics such as the history of infection control, common types of infections and pathogens, the roles and guidelines of infection control committees, and important prevention methods like hand washing. Proper infection control protocols are needed to reduce HAIs and prevent the spread of antibiotic-resistant organisms in healthcare settings.

1. HOSPITAL ASSOCIATED
INFECTIONS
Concerns and Prevention
Dr.T.V.Rao MD
6/23/2019 Dr.T.V.Rao MD'@Infection 1

2. A Tribute to
Ignaz Semmelweiss (1818-1865)
Ignaz Semmelweiss (1818-
1865)
• Established that
high maternal
mortality was due
to failure of
doctors to wash
hands after post-
mortems
• Reduced maternal
mortality by 90%
Dr.T.V.Rao MD'@Infection 26/23/2019

3. Hospital Infection
• Hospital infection is
also called
Nosocomial
infection.
• It is the single
largest factor that
adversely affects
both the patient
and the hospital
Dr.T.V.Rao MD'@Infection 36/23/2019

4. What is Hospital Acquired
Infections
•Any infection
that is not
present or
incubating at
the time the
patient is
admitted to the
hospital
Dr.T.V.Rao MD'@Infection 46/23/2019

5. Why is infection such a problem even after
100 years since Lister and Pasteur ?
• 1. Advancing age of the patients, as they are
more prone to infection.
• 2. Use of sophisticated and complicated
equipment which is not easy to clean,
disinfect or sterilize.
• 3. Increasing specialization bringing
together patients susceptible to some type
of infection.
Dr.T.V.Rao MD'@Infection 56/23/2019

6. Increasing trends
• 4. Increased use and empirical use of
antibiotics resulting in drug resistance.
•5. Higher rate of staff turnover makes it
difficult to maintain uniform standards
•6. Effective sterilization system as yet
not fully understood by all concerned.
Dr.T.V.Rao MD'@Infection 66/23/2019

7. • Additional morbidity
• Prolonged
hospitalization
• Long-term physical,
developmental and
neurological sequelae
• Increased cost of
hospitalization
• Death
Dr.T.V.Rao MD'@Infection 7
Consequences of Hospital Acquired
Infections
6/23/2019

8. Why Everyone Concerned with
Hospital Infections
• The Centers for
Disease Control
(CDC) estimates
that 2 million U.S.
patients a year
acquire hospital-
related infections.
Dr.T.V.Rao MD'@Infection 86/23/2019

9. The nature of infections
•Micro-organisms - bacteria, fungi,
viruses, protozoa and worms
•Most are harmless [non-pathogenic]
•Pathogenic organisms can cause
infection
•Infection exists when pathogenic
organisms enter the body, reproduce
and cause disease
Dr.T.V.Rao MD'@Infection 96/23/2019

10. HAI - common bacteria
• Staphylococci - wound, respiratory and
gastro-intestinal infections
• Escherichia coli - wound and urinary tract
infections
• Salmonella - food poisoning
• Streptococci - wound, throat and urinary
tract infections
• Proteus - wound and urinary tract
infections (Peto, 1998)
• C.difficle an emerging pathogen
Dr.T.V.Rao MD'@Infection 106/23/2019

11. HAI - common viruses
•Hepatitis A - infectious
hepatitis
•Hepatitis B - serum hepatitis
•Human immunodeficiency virus
[HIV] - acquired
immunodeficiency syndrome
[AIDS] (Peto, 1998)
Dr.T.V.Rao MD'@Infection 116/23/2019

12. What is Infection Control
•Infection control is the discipline
concerned with preventing nosocomial
or healthcare-associated infection. As
such, it is a practical (rather than an
academic) sub-discipline of
epidemiology. It is an essential (though
often under-recognized and under-
supported) part of the infrastructure of
health care.
Dr.T.V.Rao MD'@Infection 126/23/2019

13. Beginning of Hospital Infection
Programme
• Modern hospital infection
control programs first
began in the 1950s in
England, where the
primary focus of these
programs was to prevent
and control hospital-
acquired staphylococcal
outbreaks. In 1968, the
American Hospital
Association published
"Infection Control
in the Hospital,"
Dr.T.V.Rao MD'@Infection 136/23/2019

14. First Data on Infection Control
Efficacy
• In 1985, the Study of the
Efficacy of Nosocomial
Infection Control (SENIC)
project was published,
validating the cost-benefit
of infection control
programs. Data collected in
1970 and 1976-1977
suggested that one-third of
all nosocomial infections
could be prevented
Dr.T.V.Rao MD'@Infection 146/23/2019

15. Joint Commission on Accreditation of
Healthcare Organizations (JCAHO)
• In 1969, the Joint
Commission for
Accreditation of Hospitals--
later to become the Joint
Commission on
Accreditation of Healthcare
Organizations (JCAHO)--first
required hospitals to have
organized infection control
committees and isolation
facilities
Dr.T.V.Rao MD'@Infection 156/23/2019

16. Beginning of AIDS Pandemic
Necceciates Stronger Infection Control Protocols
• The second and certainly
most significant factor
influencing infection
control at the time was
the advent of acquired
immunodeficiency
syndrome (AIDS). HIV has
been a challenge for
education, risk reduction
and resource utilization.
Dr.T.V.Rao MD'@Infection 166/23/2019

17. Infection Control Challenges of Healthcare in
>2000
• Decreasing reimbursement
• Increasing emerging infections
• Increasing resistant organisms
• Increasing drug costs
• Nursing shortage
• OSHA safety legislations
• Multiple benchmark systems
• FDA legislation on reuse of single-use devices
Dr.T.V.Rao MD'@Infection 176/23/2019

18. Infection control was influenced by
the reform of the Healthcare System
• Infection control programs had to encompass not
only hospitals but also the long-term care facility,
home health/hospice, rehabilitation facilities, free-
standing surgical centers, and physician office
practices. A dramatic shift in patient
care practices occurred as greater
than 65% of surgery cases were
operated on in an outpatient
setting.
Dr.T.V.Rao MD'@Infection 186/23/2019

19. Identify problems with polices and procedures
Example: Pre- and Post-Operative Care
create your protocols
• Skin shaved the night
before surgery
• Inappropriate peri-op
antibiotic prophylaxis
• Instruments used for
dressing changes
submerged disinfectant
• Large containers of
antiseptics, no routine
for cleaning and refilling
Eliminate shaving of skin the
night before surgery
Single dose peri-op
antibiotic prophylaxis
guidelines
Use individual sterile packs
of wound care instruments
Use small containers of
antiseptics; clean and dry
containers before refilling
Dr.T.V.Rao MD'@Infection 19
RecommendationProblem Area
6/23/2019

20. Challenging Issues
• Issues that will continue
to impact infection
control programs into
the new millennium are
a challenging
combination of clinical
factors and increasing
cost to treat infections,
and financial impact of
implementing new
government
regulations .
Dr.T.V.Rao MD'@Infection 206/23/2019

21. Infection Control Committee and Antibiotic Policies are Back
bone for reduction of Infections
Dr.T.V.Rao MD'@Infection 216/23/2019

22. Your Unwashed Hand a Great
Concern to Your Patient
Dr.T.V.Rao MD'@Infection 226/23/2019

23. GUIDELINES AND
RECOMMENDATIONS
• Hand washing and
Hospital Environmental
Control
* Immunization
* Infectious Diseases
Control
* Intravascular Device-
Related Infections and
its control
* Isolation Precautions
Dr.T.V.Rao MD'@Infection 236/23/2019

24. Scientific Disinfection Practices
Saves Several Lives
• *Long-Term Care Facilities
*Guidelines for Infection Control in Health Care
Personnel
* Surgical Site Infections Control
* Urinary Tract and Respiratory Tract Infections
Control
* Ordering and Preparing Guidelines appropriately
• * Home care
• * Hospital Construction
• * Sterilization / Disinfection
Dr.T.V.Rao MD'@Infection 246/23/2019

25. Protecting Yourself from Blood-
Borne Pathogens
Dr.T.V.Rao MD'@Infection6/23/2019

26. HIV: 3 Infections per 1,000 Sticks with a
HIV+ Needle
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Dr.T.V.Rao MD'@Infection6/23/2019

27. Hepatitis C: 18 Persons per 1,000
Needle-sticks
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000000000000000000000000000000Dr.T.V.Rao MD'@Infection6/23/2019

28. Hepatitis B is Most Infectious
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Dr.T.V.Rao MD'@Infection6/23/2019

29. Safe Handling of Sharps
• Wear gloves when
drawing blood or
handling sharps—double
glove for surgery
•Don’t recap!
• Don’t bend or break
needles
• Never place used sharps
on tables, beds, furniture
• Put used sharps
immediately into a
sharps container
Dr.T.V.Rao MD'@Infection 296/23/2019

30. Infection Control Committee - Represented
Committee Representatives
• Hospital Epidemiologist
• Infection Control Practitioners
• Administrator
• Ward, ICU and Operating room Nurses
• Medicine/Surgery/Obstetrics/Pediatrics
• Central Sterilization
• Hospital Engineer
• Microbiologist
• Pharmacist
Dr.T.V.Rao MD'@Infection 306/23/2019

31. Hand Washing is the Foundation of
Infection Control
• Hand washing is the single
most important procedure for
preventing nosocomial
infections.. Although various
products are available, hand
washing can be classified
simply by the nature of the
products used:
• plain soap
• detergents
• Antimicrobial containing
products
Dr.T.V.Rao MD'@Infection 316/23/2019

32. Successful Promotion
in Hand Washing 
• Education
• Routine observation & feedback
• Engineering controls
• Location of hand basins
• Possible, easy & convenient
• Alcohol-based hand rubs available
• Patient education
(Improving Compliance with Hand Hygiene in Hospitals. Didier Pittet. Infection Control and Hospital
Epidemiology. Vol. 21 No. 6 Page 381)
Dr.T.V.Rao MD'@Infection 326/23/2019

33. Successful Promotion
Can Improve Hand Washing 
• Reminders in the
workplace
• Administrative
sanctions ??
• Promote and
facilitate skin care
• Avoid understaffing
and excessive
workload
Dr.T.V.Rao MD'@Infection 336/23/2019

34. Computerized Surveillance
• Surveillance
traditionally involved
significant manual data
assessment Increasingly,
integrated
computerized software
solutions are becoming
available that assess
incoming risk messages
from microbiology and
other online sources.
Dr.T.V.Rao MD'@Infection 346/23/2019

35. Infection Control Programme and
Documentation
• Goals of the infection
control program need
to be incorporated into
the mission statement
of the facility. A
mission statement
should tell who you
are, what you do, and
should communicate a
clear view of purpose
and set a strategy for
accomplishing the goal
Dr.T.V.Rao MD'@Infection 356/23/2019

36. Waste disposal
• Clinical waste - HIGH risk
• potentially/actually contaminated waste including body
fluids and human tissue
• yellow plastic sack, tied prior to incineration
• Household waste - LOW risk
• paper towels, packaging, dead flowers, other waste
which is not dangerously contaminated
• black plastic sack, tied prior to incineration
• Follow local policy (May, 2000)
Dr.T.V.Rao MD'@Infection 366/23/2019

37. Health Care Means In patient care
and outpatient care
• Significant trends in
healthcare are occurring
everyday including new
medical procedures (i.e.,
gene therapy, Stem cell
therapy), new
technology (multi-
purpose intravenous
catheters), and a shift
from inpatient to
outpatient care.
Dr.T.V.Rao MD'@Infection 376/23/2019

38. Surveillance
• The key to ongoing
monitoring is
surveillance for
nosocomial infections.
Various techniques for
surveillance have been
described and evaluated
including total house
surveillance, targeted
surveillance, Kardex, or
laboratory-base
Dr.T.V.Rao MD'@Infection 386/23/2019

39. What we need and what to do
• One infection control professional (ICP) for every
250 beds.
• An effective infection control physician.
• A program reporting infection rates back to the
surgeon and those clinically involved with the
infection.
• An organized hospital-wide surveillance system.
Dr.T.V.Rao MD'@Infection 396/23/2019

40. NEW TECHNOLOGIES IN
HOSPITAL INFECTIONS
Dr.T.V.Rao MD'@Infection 406/23/2019

41. Light technology to combat
Hospital Infections
• A pioneering lighting
system that can kill hospital
superbugs – including
MRSA and C.diff – has been
developed by researchers
at the University of
Strathclyde in Glasgow,
Scotland. The technology
decontaminates the air and
exposed surfaces by
bathing them in a narrow
spectrum of visible-light
wavelengths, known as
HINS-light.
Dr.T.V.Rao MD'@Infection 416/23/2019

42. Light Technology to Combat Hospital Infections
• HINS-light is a safe
treatment that can be
easily automated to
provide continuous
disinfection of wards and
other areas of the
clinical environment. The
pervasive nature of light
permits the treatment of
air and all visible
surfaces, regardless of
accessibility, either
through direct or
reflected exposure to
HINS-light within the
treated environment
Dr.T.V.Rao MD'@Infection 426/23/2019

43. Medical Dressing Uses Nanotechnology to Fight
Infection
• Scientists at the
University of Bath and
the burns team at the
Southwest UK Pediatric
Burns Centre at
Frenchay Hospital in
Bristol are working
together with teams
across Europe and
Australia to create an
advanced wound
dressing.
Dr.T.V.Rao MD'@Infection 436/23/2019

44. New Bandages Change Color If
Infections Arise
• The dressing will work
by releasing antibiotics
from Nano capsules
triggered by the
presence of disease-
causing pathogenic
bacteria, which will
target treatment
before the infection
takes hold.
Dr.T.V.Rao MD'@Infection 446/23/2019

45. Document Antibiograms With
WHONET
• WHONET is a free
Windows-based database
software developed for
the management and
analysis of microbiology
laboratory data with a
special focus on the
analysis of antimicrobial
susceptibility test results.
Dr.T.V.Rao MD'@Infection 456/23/2019

46. Recent Studies on Infection Control
and Prevention
Dr.T.V.Rao MD'@Infection 466/23/2019

47. Long Sleeves x Short Sleeves
• Scientific studies showed there
were no statistically significant
differences found in bacterial or
MRSA counts between
physicians’ coats and newly
laundered short-sleeved
uniforms. The researchers’
findings sheds new light on
British government agencies’
policies banning physicians’
white coats based on the belief
that long sleeves carry more
bacteria and pose a greater risk
of bacterial transmission
Dr.T.V.Rao MD'@Infection 476/23/2019

48. Involvement of Physicians More
Important
Physicians to be more
involved and lead quality
improvement efforts in
their respective
healthcare settings. One
of the reasons for this
lack of progress, they
say, is inadequate
physician engagement
and leadership in quality
improvement work.
Peter Pronovost, MD, PhD, and Jill
Marsteller, PhD, MP
Dr.T.V.Rao MD'@Infection 486/23/2019

49. Scientific Documentation Reduces
Hospital Infections
• Researchers evaluated the
effect of an electronic
medical record on the use
of antimicrobial agents
and infection rates of
Clostridium difficile and
MRSA. Results showed
that implementation of an
EMR significantly
increased chart reviews
and antimicrobial
recommendations, leading
to a decrease in
antimicrobial use and
MRSA as well as C. difficile
infection rates.
Dr.T.V.Rao MD'@Infection 496/23/2019

50. Impact of Hand Washing on
Influenza
• Health experts believe a flu
epidemic was averted last year
because of regular hand-
washing, suggesting healthcare
facilities should promote hand-
washing among staff and
patients to prevent the spread
of disease. The American Society
for Microbiology and the
American Cleaning Institute
released a study in Sept. 2010
reporting that 85 percent of
people washed their hands in
public restrooms in 2008, the
highest levels observed since the
research began in 1996.
Dr.T.V.Rao MD'@Infection 506/23/2019

51. Hand Hygiene Compliance
• Researchers have
implemented a hand
hygiene program driven
by a behavioral change
approach to increase
hand hygiene
compliance.. It
included access to
alcohol sanitizer,
education as well as
ongoing audit and
feedback.
Dr.T.V.Rao MD'@Infection 516/23/2019

52. Yet no Ideal Chemical Agent
• Researchers concluded
that each prep agent
has specific advantages
and disadvantages and
no one skin prep agent
is superior in all clinical
situations. Factors to
consider when
choosing a skin prep
agent include surgeon
preference and
environmental risks.
Dr.T.V.Rao MD'@Infection 526/23/2019

53. Hand Hygiene Techniques
Many Ways
1. Alcohol hand rub
2. Routine hand wash
10-15 seconds
3. Aseptic procedures 1
minute
4. Surgical wash 3-5
minutes
Dr.T.V.Rao MD'@Infection 536/23/2019

54. Advantages of Alcoholic Hand
Wash
• Require less time
• Can be strategically
placed
• Readily accessible
• Multiple sites
• All patient care areas
• Acts faster
• Excellent bactericidal
activity
• Less irritating (??)
• Sustained improvement
Dr.T.V.Rao MD'@Infection 546/23/2019

55. Hand washing – Areas Missed
Taylor (1978)
identified that 89% of
the hand surface was
missed and that the
areas of the hands
most often missed
were the finger-tips,
finger-webs, the
palms and the
thumbs.
Dr.T.V.Rao MD'@Infection 556/23/2019

56. Health Care Workers are at Risk –
Need for Vaccination
• Health care workers may be exposed to certain
infections in the course of their work. Vaccines are
available to provide some protection to workers in
a healthcare setting. Depending on regulation,
recommendation, the specific work function, or
personal preference, healthcare workers or first
responders may receive vaccinations for
hepatitis B; influenza Measles,
mumps and rubella; Diphtheria,
Pertussis; N. meningitides; and
varicella.
Dr.T.V.Rao MD'@Infection 566/23/2019

57. Who will pay us ???
•The problem of
resources for
proving Vaccines
in Developing
countries
continues to be
real problem,
need additional
economic
resourcesDr.T.V.Rao MD'@Infection 576/23/2019

58. Training Every One..
Is it a Easy Job ???
• This is the single
most important
factor in the control
of Hospital
infection. A high
sense of awareness
and training goes a
long way in
controlling Hospital
infection.
Dr.T.V.Rao MD'@Infection 586/23/2019

59. Let us support our hospitals with
clean hands
Dr.T.V.Rao MD'@Infection 596/23/2019

60. Soap Water and Common sense are Best
Antiseptics- William Osler
Dr.T.V.Rao MD'@Infection 606/23/2019

61. •Program created by Dr.T.V.Rao MD for
benefit of Medical, Nursing and
Paramedical professionals
• Email
•doctortvrao@gmail.com
Dr.T.V.Rao MD'@Infection 616/23/2019